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Related to GM-CSF: interleukin, Cytokines, Sargramostim

sargramostim (GM-CSF)


Pharmacologic class: Granulocytemacrophage colony stimulating factor

Therapeutic class: Hematopoietic agent

Pregnancy risk category C


Stimulates proliferation and differentiation of hematopoietic cells that activate mature granulocytes and macrophages of target cells


Liquid: 500 mcg/ml

Powder for injection: 250 mcg

Indications and dosages

Post peripheral blood progenitor cell (PBPC) transplantation

Adults: 250 mcg/m2/day I.V. over 24 hours or subcutaneously once daily, starting immediately after progenitor cell infusion

Mobilization of PBPCs into peripheral blood for collection by leukapheresis

Adults: 250 mcg/m2/day I.V. over 24 hours or subcutaneously once daily, continued throughout harvesting

Neutrophil recovery after chemotherapy in acute myelogenous leukemia Adults: 250 mcg/m2/day I.V. over 4 hours, starting 4 days after completion of chemotherapy induction

Bone-marrow transplantation failure or engraftment delay

Adults: 250 mcg/m2/day as 2-hour I.V. infusion for 14 days. If engraftment doesn't occur, may repeat after 7 days of drug hiatus.

Myeloid reconstitution after autologous or allogeneic bone-marrow transplantation

Adults: 250 mcg/m2/day as a 2-hour I.V. infusion, starting 2 to 4 hours after autologous bone marrow infusion and at least 24 hours after last chemotherapy or radiotherapy dose

Off-label uses

• Crohn's disease
• Melanoma
• Wound healing
• Mucositis
• Stomatitis
• Vaccine adjuvant


• Hypersensitivity to drug, its components, or yeast products
• Excessive leukemic myeloid blasts in bone marrow or peripheral blood (10% or more)
• Within 24 hours before or after chemotherapy or radiation therapy


Use cautiously in:
• renal or hepatic insufficiency, fluid retention, pulmonary disorders, pulmonary infiltrates, heart failure, leukocytosis, transient supraventricular arrhythmias
• cancer patients undergoing sargramostim-mobilized PBPC collection
• patients receiving purged bone marrow or previously exposed to intensive chemotherapy or radiation therapy
• pregnant or breastfeeding patients
• children.


Don't give within 24 hours of chemotherapy or radiation therapy.
• Add 1 ml of sterile water to powder for injection by directing water stream against side of vial and swirling vial gently to disperse contents.
• Avoid shaking or agitating solution.
• For a final drug concentration below 10 mcg/ml, add human albumin 0.1% to saline solution; then dilute drug in normal saline solution.
• Infuse as soon as possible after reconstitution, but no more than 6 hours after mixing.
• Don't add other drugs to infusion; don't use in-line filter.

Adverse reactions

CNS: malaise, asthenia

CV: peripheral edema, tachycardia, hypotension, transient supraventricular tachycardia, pericardial effusion

GI: nausea, vomiting, diarrhea, anorexia, stomatitis, GI hemorrhage

GU: urinary tract disorder, abnormal renal function

Hematologic: blood dyscrasias, hemorrhage

Hepatic: hepatic damage

Musculoskeletal: joint pain, myalgia, bone pain

Respiratory: dyspnea, lung disorder

Skin: rash, alopecia

Other: fever, chills, sepsis, edema, first-dose reaction (respiratory distress, hypoxia, syncope, tachycardia, hypotension, flushing)


Drug-drug.Corticosteroids, lithium: potentiation of myeloproliferative effects

Vincristine: severe peripheral neuropathy

Patient monitoring

• Monitor for dyspnea. Halve dosage and contact prescriber if dyspnea occurs.
• Assess CBC with white cell differential. Check for presence of blast cells, and watch for signs and symptoms of blood dyscrasias.
• Closely monitor vital signs and fluid intake and output. Stay alert for signs and symptoms of fluid overload.

Monitor liver function tests, and watch for evidence of hepatic damage and bleeding (especially GI hemorrhage).

Patient teaching

Tell patient sargramostim is a powerful drug that can cause significant adverse reactions. Teach him to recognize and report serious reactions at once.

Instruct patient to immediately report unusual bleeding or bruising or yellowing of skin or eyes.
• Tell patient drug may cause weakness and musculoskeletal pain.
• Inform patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.



granulocyte-macrophage colony-stimulating factor.


granulocyte-macrophage colony-stimulating factor



A gene on chromosome 5q23-q31 that encodes colony stimulating factor 2 (granulocyte-macrophage), a cytokine that controls the production, differentiation and function of granulocytes and macrophages.

Molecular pathology
CSF2 is localised to a cluster of related genes at chromosome 5q31, a region associated with deletions in the 5q- syndrome and acute myelogenous leukaemia.


Granulocyte macrophage-colony stimulating factor, sargramostim, Leukine, Prokine A hematopoietic growth factor and immune modulator produced by granulocytes, macrophages, monocytes, lymphocytes, fibroblasts, endothelial cells; rGM-CSF–sargramostim may be used to ↑WBCs in AIDS, or stimulate hematopoiesis after high dose chemotherapy in autologous BMT; it may be used as an immune 'tonic' in CA and AIDS Pts, anemia, ↑ survival of BMTs, ↓ infections in congenital neutropenia Adverse effects Bone pain, rash, fever. See Biological response modifiers, Sargramostim. Cf G-CSF.


Abbreviation for granulocyte-macrophage colony-stimulating factor.

Granulocyte/macrophage colony stimulating factor (GM-CSF)

A substance produced by cells of the immune system that stimulates the attack upon foreign cells. Used to treat prostate cancers as a genetically engineered component of a vaccine that stimulates the body to attack prostate tissue.
Mentioned in: Prostate Cancer

granulocyte colony-stimulating factor

; G-CSF; granulocyte-macrophage colony-stimulating factor; GM-CSF cytokines that promote bone marrow cell mitosis


granulocyte-macrophage colony-stimulating factor.
References in periodicals archive ?
It is clear that the mRNA levels for IL-6 and GM-CSF are very high in resting lung fibroblasts.
At 11-years follow-up, post-vaccination GM-CSF producing anti-tumor T-cells were significantly associated with overall survival and time-to-next-treatment benefits.
The researchers analyzed three rheumatoid arthritis growth factors in mouse models and identified the signaling protein GM-CSF as the most promising for potential protective benefit against Alzheimer's disease.
It combines an oncolytic effect while inducing tumour cells to secrete GM-CSF, a powerful immune stimulator, potentially enhancing the destruction of metastatic tumour deposits.
Results of an unusual "clinical trial' involving GM-CSF agree with the promising findings of more formal studies, says Robert P.
1st and next generation GM-CSF products in regulated markets
They exposed a group of mice, half of which had been treated with a GM-CSF blocking agent, anti-GM-CSF, and half of which were controls, to the equivalent of nine cigarettes of smoke each day for four days.
Normally present in the blood in small quantities, GM-CSF stimulates the proliferation and function of certain white blood cells.
Given the hyper-sensitivity of CMML cells to GM-CSF, and the cell killing we have seen in our pre-clinical work as a result of depriving CMML cells of GM-CSF using KB003, we are hopeful that KB003 will prove to be an effective therapeutic for patients suffering from CMML.
It is the only product in clinical development that combines an oncolytic effect while inducing tumor cells to secrete GM-CSF, a powerful immune stimulator, potentially enhancing the destruction of metastatic tumor deposits.
3 NEW ENGLAND JOURNAL OF MEDICINE that GM-CSF is both nontoxic and capable of boosting the number of white cells in the body, suggesting a possible treatment for disorders with depressed white cell counts.